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Although numerous national and international clinical practice guidelines have been published over the past decade, their translation into evidence\u2010based and equitable care remains inconsistent. This narrative review critically evaluates 47 obesity guidelines published between 2014 and 2026 across North America, Europe, Latin America, the Asia\u2010Pacific region, and the World Health Organization to identify conceptual, structural, and implementation gaps that continue to fragment obesity care. Despite broad recognition of obesity as a chronic, relapsing disease, most guidelines continue to rely primarily on body mass index (BMI), with limited incorporation of accessible anthropometric measures, body composition assessment, and metabolic phenotyping. Lifestyle recommendations for nutrition, physical activity, and behavioral interventions remain largely descriptive, while access to pharmacotherapy and metabolic surgery is strongly influenced by regulatory and socioeconomic factors. Emerging advances, including GLP\u20101 receptor agonists, dual incretin therapies, body composition\u2013guided assessment, and anti\u2010stigma approaches, have been only partially incorporated into routine recommendations. Rather than redefining obesity, this review proposes a pragmatic, implementation\u2010oriented framework that integrates scalable strategies including anthropometric risk assessment, healthy dietary patterns, physical activity, behavioral support, non\u2010stigmatizing care, and equitable access to effective therapies with selective use of precision medicine and body composition assessment. Greater harmonization of clinical, behavioral, compositional, and policy domains is needed to achieve feasible, equitable, and sustainable improvements in metabolic and functional health outcomes.<\/jats:p>","DOI":"10.1111\/obr.70209","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T06:36:35Z","timestamp":1787380595000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking Global Obesity Guidelines: Integrating Evidence, Equity and Precision (2014\u20132026)"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4384-8629","authenticated-orcid":false,"given":"Rosero\u2010Revelo","family":"Ricardo","sequence":"first","affiliation":[{"name":"Endocrinology &amp; Metabolism Department, Medical Specialty Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamayo","family":"Mateo","sequence":"additional","affiliation":[{"name":"Obesity Center Fundaci\u00f3n Santa Fe de Bogot\u00e1  Bogot\u00e1 D.C. Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1353-148X","authenticated-orcid":false,"given":"Henao","family":"Diana","sequence":"additional","affiliation":[{"name":"Endocrinology Department Javeriana University  Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan P.","family":"Polanco","sequence":"additional","affiliation":[{"name":"Cardiovascular Risk Institute Cardiovida Clinic  Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cort\u00e9s","family":"David","sequence":"additional","affiliation":[{"name":"Endocrinology Department Javeriana University  Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Alba","sequence":"additional","affiliation":[{"name":"Psychiatry Department Pedagogical &amp; Tech University of Colombia  Tunja Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giha","family":"Valeria","sequence":"additional","affiliation":[{"name":"Chaplin School of Hospitality &amp; Tourism Management Florida International University  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camargo","family":"Camilo","sequence":"additional","affiliation":[{"name":"Obesity Center San Rafael University Hospital  Tunja Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hern\u00e1ndez","family":"Eder","sequence":"additional","affiliation":[{"name":"Obesity Center NorthUnivesity Hospital  Barranquilla Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Correa","family":"Ricardo","sequence":"additional","affiliation":[{"name":"Endocrinology &amp; Metabolism Department, Medical Specialty Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nassar","family":"Ricardo","sequence":"additional","affiliation":[{"name":"Obesity Center Fundaci\u00f3n Santa Fe de Bogot\u00e1  Bogot\u00e1 D.C. Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cabandugama","family":"Peminda","sequence":"additional","affiliation":[{"name":"Endocrinology &amp; Metabolism Department, Medical Specialty Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcio L.","family":"Griebeler","sequence":"additional","affiliation":[{"name":"Endocrinology &amp; Metabolism Department, Medical Specialty Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burguera","family":"Bartolome","sequence":"additional","affiliation":[{"name":"Endocrinology &amp; Metabolism Department, Medical Specialty Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20108587(24)00316\u20104"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13190"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.706978"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/ewjm.172.2.78"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574\u2010019\u20100176\u20108"},{"key":"e_1_2_9_7_1","first-page":"673","volume-title":"The Epidemiology of Obesity: A Big Picture. 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